Jeremy Douglas, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA27275 Issued in FL

Practice address

4842 SW Archer Rd
Gainesville, FL 32608-3813

Phone

(352) 378-7172

Fax

(352) 382-1146

NPI assigned

Nov 30, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1174281828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8477 S SUNCOAST BLVD",
            "city": "HOMOSASSA",
            "state": "FL",
            "postal_code": "344465028",
            "telephone_number": "800-804-9961",
            "fax_number": "352-382-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4842 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326083813",
            "telephone_number": "352-378-7172",
            "fax_number": "352-382-1146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "JEREMY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-30",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA27275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Paulson Dougherty
• Yinting Lo Dougherty, PA-C
• Martha Victoria Douglas-Escobar, MD
• Ashton Douglas, LMHC
• Cortney D Douglas
• Leigh Anne Douglas, L.M.T.
• Sommer Renee Douglass
• Grace Dourado, PH.D.
• Rylan Jacob Douthett, DNP, APRN, FNP-BC
• Kelley Dow, R.D., L.D.

• Physical Therapy Assistant in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.